Date of Paper/Work


Type of Paper/Work

Doctor of Nursing Practice Project

Degree Name

Doctor of Nursing Practice



First Advisor

Gretchen A. Moen


Doctor of Nursing Practice


Children who are exposed to traumatic events are more likely to engage in risky behaviors, are at increased risk for developing lifelong health problems, and are less likely to reach their full academic and career potential (Centers for Disease Control and Prevention [CDC], 2019). The American Academy of Pediatrics endorses screening for toxic stress within the pediatric primary care setting; however, this recommendation has not been widely implemented (Garner & Shonkoff, 2012). A quality improvement project aiming to increase provider knowledge of ACEs and implement the use of an ACEs screening tool was performed in a small urban pediatric primary care clinic. The impact of a provider education session was evaluated via a pre-post-test design and utilization of the patient and/or caregiver completed Pediatric ACEs and Related Life-events Screener (PEARLS) was monitored over a 16-week period. Initially, an increase in provider knowledge was achieved following the educational session; however, this increase in knowledge was not sustained at the end of the 16 weeks. During the implementation period, 89.5% (343 of 383) of eligible patients were given the opportunity to complete a PEARLS, with a 66.5% (228 of 343) completion rate. Results demonstrated feasibility and acceptability of using the PEARLS at yearly well child exams. Further research is needed on how to sustain provider engagement, improve provider knowledge retention, and determine whether or not an improvement in provider ACEs knowledge leads to the implementation of appropriate interventions for affected children.